Re: SUA

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Let me spend a few moments reviewing this for other readers without a medical background. Normally, there are 3 umbilical blood vessels, which are 2 arteries and a vein. The umbilical cord travels from the placenta to the baby's umbilicus (belly button); it's job is to carry blood, oxygen and nutrients to the baby, and to return carbon dioxide and waste to the mother's blood.

A single umbilical artery (SUA) is found in roughly 0.8% of babies, although the number is higher in twins. Caucasian women have this condition about twice as often as African-American women. A number of larger studies have shown that about 1/3 of babies with SUA have some type of anomaly (birth defect). As you wrote, these include heart defects, intestinal problems, and brain or spinal cord abnormalities. Some have chromosomal problems. Even those that don't have obvious problems may be at risk for growth restriction and stillbirth later in pregnancy.

Here is how me manage this condition: Patients with SUA are referred to a nearby perinatologist, who can perform a targeted ultrasound, at about 16-18 weeks, and who can perform an amniocentesis to rule out a chromosomal anomaly. (As an aside, a number of ob/gyn's can also do these, but perinatologists generally see more of this and have better ultrasound equipment). A fetal echocardiagram is performed by the perinatologist at 22 weeks, as this is just about the best time to look at the fetal heart. If no abnormalities are found on the testing thus far, I would consider more frequent office visits later in pregnancy (as an example, around 32 weeks), with measurements of uterine size by tape measure. We give patients written and verbal information on kick counts, and advise them to come in ASAP if the fetal movements are less that 10 times in 4 hours (there are other regimens for this). I would usually suggest serial ultrasounds, starting at roughly 28-32 weeks (depends on the situation) every 2-4 weeks to check for growth restriction and low fluid. I usually also obtain non-stress testing (NSTs) from about 30-32 weeks onward.

Please understand that I have never seen a study comparing the above intervention to doing nothing. However, we manage similar problems in pregnancy this way, with good outcomes. The above is expensive. Ultrasounds run $100-400 each, and NST's are about $70 each. It makes sense, though, to look for growth restriction by comparing serial ultrasounds, and to keep track of fetal movements (and perhaps NSTs) to also evaluate fetal well-being.

Good luck with everything. I'll keep my fingers crossed that everything works out well.

--
David Ashley Hill, M.D.
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital Family Practice Residency
Orlando, Florida
http://home.mpinet.net/dahmd

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